The rate of secondary malignancies after radical prostatectomy versus external beam radiation therapy for localized prostate cancer: a population-based study on 17,845 patients.

Abstract

PURPOSE:

External-beam radiation therapy (EBRT) may predispose to secondary malignancies that include bladder cancer (BCa), rectal cancer (RCa), and lung cancer (LCa). We tested this hypothesis in a large French Canadian population-based cohort of prostate cancer patients.

METHODS AND MATERIALS:

Overall, 8,455 radical prostatectomy (RP) and 9,390 EBRT patients treated between 1983 and 2003 were assessed with Kaplan-Meier and Cox regression analyses. Three endpoints were examined: (1) diagnosis of secondary BCa, (2) LCa, or (3) RCa. Covariates included age, Charlson comorbidity index, and year of treatment.

RESULTS:

In multivariable analyses that relied on incident cases diagnosed 60 months or later after RP or EBRT, the rates of BCa (hazard ratio [HR], 1.4; p = 0.02), LCa (HR, 2.0; p = 0.004), and RCa (HR 2.1; p <0.001) were significantly higher in the EBRT group. When incident cases diagnosed 120 months or later after RP or EBRT were considered, only the rates of RCa (hazard ratio 2.2; p = 0.003) were significantly higher in the EBRT group. In both analyses, the absolute differences in incident rates ranged from 0.7 to 5.2% and the number needed to harm (where harm equaled secondary malignancies) ranged from 111 to 19, if EBRT was used instead of RP.

CONCLUSIONS:

EBRT may predispose to clinically meaningfully higher rates of secondary BCa, LCa and RCa. These rates should be included in informed consent consideration.

• Authors: Naeem Bhojani, Umberto Capitanio, Nazareno Suardi, Claudio Jeldres, Hendrik Isbarn, Shahrokh F Shariat, Markus Graefen, Philippe Arjane, Alain Duclos, Jean-Baptiste Lattouf, Fred Saad, Luc Valiquette, Francesco Montorsi, Paul Perrotte, Pierre I Karakiewicz
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 76 Issue 2 Pg. 342-8 (Feb 01 2010) ISSN: 1879-355X [Electronic] United States
• PMID: 20117287 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• France (ethnology)
• Humans
• Incidence
• Kaplan-Meier Estimate
• Lung Neoplasms (epidemiology, etiology)
• Male
• Middle Aged
• Neoplasms, Radiation-Induced (epidemiology)
• Neoplasms, Second Primary (epidemiology, etiology)
• Prostatectomy (adverse effects)
• Prostatic Neoplasms (ethnology, pathology, radiotherapy, surgery)
• Quebec (epidemiology, ethnology)
• Radiotherapy (adverse effects)
• Rectal Neoplasms (epidemiology, etiology)
• Regression Analysis
• Urinary Bladder Neoplasms (epidemiology, etiology)